Haigh P I, Hansen N M, Qi K, Giuliano A E
Division of Surgical Oncology, John Wayne Cancer Institute at Saint John's Health Center, Santa Monica, California 90404, USA.
Ann Surg Oncol. 2000 Jan-Feb;7(1):21-7. doi: 10.1007/s10434-000-0021-1.
Sentinel lymph node dissection (SLND) is becoming a recognized technique for accurately staging patients with breast cancer. Its success in patients with large tumors or prior excisions has been questioned. The purpose of this study was to evaluate the effect of biopsy method, excision volume, interval from biopsy to SLND, tumor size, and tumor location on SLND success rate.
Consecutive patients who underwent SLND followed by completion axillary lymph node dissection from October 1991 to December 1995 were analyzed. Included were cases performed early in the series before the technique was adequately developed. Excision volume was derived from the product of three dimensions as measured by the pathologist. Two end points were analyzed: sentinel node identification rate and accuracy of SLND in predicting axillary status. Univariate analyses using chi2 or Fisher's exact test for categorical variables and Wilcoxon rank sums for continuous variables were performed. Multivariate analysis was performed using logistic regression.
There were 284 SLND procedures performed on 283 patients. Median age was 55 years. The most recent biopsy method used before SLND was stereotactic core biopsy in 41 (14%), fine-needle aspiration in 62 (22%), and excision in 181 (64%) procedures. The mean excision volume was 32 ml with a range of 0.3-169 ml. The mean time from biopsy to SLND was 17 days with a range of 0-140 days. The mean tumor size was 2.0 cm (15 Tis [5%], 184 T1 [65%], 72 T2 [25%], and 13 T3 [5%]). Tumors were located in the outer quadrants in 74%, the inner quadrants in 18%, and subareolar region in 8%. The sentinel node was identified in 81%, and 39% had metastases. There were three false-negative cases early in the series. Sensitivity was 97%, and accuracy was 99%. Negative predictive value was 98% in cases in which the sentinel node was identified. On the basis of biopsy method, excisional volume, time from biopsy to SLND, tumor size, and tumor location, there was no statistically significant difference (P>.05) in sentinel node identification rate or accuracy of SLND.
SLND has a high success rate in breast cancer patients regardless of the biopsy method or the excision volume removed before SLND. In addition, the interval from biopsy to SLND, tumor size, and tumor location have no effect on the success rate of SLND, even in this series which included patients operated on before the technique was adequately defined. Patients with breast cancers located in any quadrant and diagnosed either with a needle or excisional biopsy could be evaluated for trials of SLND.
前哨淋巴结清扫术（SLND）正成为一种用于准确分期乳腺癌患者的公认技术。其在大肿瘤或既往有切除史患者中的成功率受到质疑。本研究的目的是评估活检方法、切除体积、活检至SLND的间隔时间、肿瘤大小和肿瘤位置对SLND成功率的影响。
对1991年10月至1995年12月期间连续接受SLND并随后完成腋窝淋巴结清扫的患者进行分析。纳入了该技术充分发展之前该系列早期进行的病例。切除体积由病理学家测量的三维乘积得出。分析了两个终点：前哨淋巴结识别率和SLND预测腋窝状态的准确性。对分类变量使用卡方检验或Fisher精确检验，对连续变量使用Wilcoxon秩和检验进行单变量分析。使用逻辑回归进行多变量分析。
对283例患者进行了284次SLND手术。中位年龄为55岁。SLND前使用的最新活检方法为立体定向芯针活检41例（14%）、细针穿刺抽吸62例（22%）和切除活检181例（64%）。平均切除体积为32 ml，范围为0.3 - 169 ml。活检至SLND的平均时间为17天，范围为0 - 140天。平均肿瘤大小为2.0 cm（15例Tis [5%]，184例T1 [65%]，72例T2 [25%]，13例T3 [5%]）。肿瘤位于外象限的占74%，内象限的占18%，乳晕下区域的占8%。前哨淋巴结识别率为81%，其中39%有转移。该系列早期有3例假阴性病例。敏感性为97%，准确性为99%。在前哨淋巴结被识别的病例中，阴性预测值为98%。基于活检方法、切除体积、活检至SLND的时间、肿瘤大小和肿瘤位置，前哨淋巴结识别率或SLND的准确性无统计学显著差异（P >.05）。
无论活检方法或SLND前切除的体积如何变化，SLND在乳腺癌患者中均有较高的成功率。此外，活检至SLND的间隔时间、肿瘤大小和肿瘤位置对SLND的成功率没有影响，即使在该系列包括技术尚未充分明确时接受手术的患者中也是如此。位于任何象限且通过针吸活检或切除活检诊断的乳腺癌患者均可接受SLND试验评估。
